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$2,000 rollover example

First qualifying year

A member has one cleaning, one regular exam and a total of $300 in paid claims,
which is less than the threshold limit. Therefore, the member earns a $400
rollover benefit that is added to the rollover account.

Benefit in year two

Annual Rollover Total annual maximum
maximum account with rollover
$2,000 + $400 = $2,400

The member has one cleaning, one regular exam and a total of $300 in paid claims,
which is less than the threshold limit. Therefore, the member earns another $400
rollover benefit that is added to the rollover account.

Benefit in year three

Annual Rollover Total annual maximum
maximum account with rollover
$2,000 + $800 = $2,800

The member has one cleaning, one regular exam and a total of $2,200 in paid
claims, which is over the threshold limit. He or she will not earn a rollover benefit,
but is able to use the benefit earned in previous years to help pay the $2,200 in
claims. Also, because the entire $800 rollover benefit is not used, $600 will remain
in the rollover account.

Benefit in year four

Annual Rollover Total annual maximum
maximum account with rollover
$2,000 + $600 = $2,600
ColonialLife.com
The member has $2,600 available to use in this year because of the $2,000 regular
annual maximum plus $600 in remaining rollover benefit.

This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary

or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details
of coverage and availability, please refer to Policy Form IDN8000 or contact your Colonial Life benefits counselor.
©2018 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand
of Colonial Life & Accident Insurance Company. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.

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